Dosher Weighs In On Medicaid Expansion

Dosher Memorial Hospital joined several other rural hospitals recently to support expanding Medicaid coverage in North Carolina.

The hospital provides an estimated 2,500 emergency room visits to uninsured patients annually, resulting in nearly $8.8 million in uncompensated care and about $760,000 in charity care, according to a resolution Dosher’s board of trustees adopted.

“… expanding Medicaid coverage would extend insurance to approximately 500,000 people across North Carolina, including many residents of Brunswick County,” the resolution stated. “… closing the coverage gap would create 43,000 new jobs in North Carolina and generate billions of dollars in new North Carolina business activity.”

In 2012 when the U.S. Supreme Court weighed in on the validity of the Affordable Care Act, the justices upheld the law’s individual mandate that required people to have insurance coverage. But the court at the same time found that the ACA overstepped when it called for a penalty on states that did not expand Medicaid coverage, which is funded by federal and state governments, effectively making it an optional policy decision.

Under the ACA, in an effort to expand coverage of uninsured people, participation in the Medicaid expansion meant covering a substantially larger pool of eligible individuals. For states participating in the program, the federal government plans to cover 90% of most states’ costs for 2020 on.

Thirty-seven states have adopted Medicaid expansion, according to the Kaiser Family Foundation, a nonprofit that studies health care issues. Of those states, three have adopted the expansion but not yet implemented it.

Gov. Roy Cooper would like to see North Carolina join the list.

He held a roundtable in late April with leaders of seven hospitals on the issue, an event that included Dosher’s CEO and president Tom Siemers.

Democrats turned in expansion bills at the start of the session.

House Republicans also filed a bill in the General Assembly to address the coverage gap. The measure, co-sponsored by Rep. Holly Grange, R-New Hanover, includes an annual premium for covered participants equal to 2% of household income, copays, an emphasis on health and wellness and work requirements for some participants.

The work requirements portion already is a sticking point for Democrats, and the question of how the remaining 10% not covered by the federal government will be paid for will be debated.

And then there is the fact that Senate Republican leaders remain staunchly opposed to any Medicaid expansion move, pointing to the impact on current Medicaid enrollees and calling it unsustainable.

The bills have not come to the Senate floor, and if they actually gain traction could get worked out in conference committees in May or June, estimated Sen. Harper Peterson, D-New Hanover.

“It’s probably the most important piece of legislation we could pass,” he said.